GAA opt against mandatory screening

[Corner Back]

Good post Down22, you're well read about the subject and the shortcomings of screening for some people, but I think you've already answered the riddle you pose.

The only way we are going to get more information on these conditions is by doing more screening. Otherwise we keep our heads in the sand and just watch young people die suddenly forever more. We don't say, cancer is a difficult condition, so we shouldn't really do anything - that's why we spend millions on researching for a cure for it. Ditto AIDS, SARS, Bird Flu, meningitis.

The facts are that the Italians, by doing lots of screening, are cutting the number of deaths. Few medical procedures are ever simple or perfect, but we must follow best practice.

Like PhP, I lost a good friend to one of these heart defects and I am amazed that people can say, "it's too difficult, let's not bother".

[down22]

I think one of the main problems with this whole issue is the lack of knowledge. These cardiac conditions are very rare and this makes properly controlled research (such as randomised control trials) impossible. The treatment for many of these rare cardiac conditions is usually based on small, non-randomised trials. However, due to the rare nature of these conditions there never will be proper randomised control trials (they would also be unethical). So important decisions are made on the limited evidence available.

The study cited in the article is based on a population study carried out in one region of Italy. It's been a while since I read the full artice (will look it out) but from what I remember it does show promising results.(however, it is subject to the bias associated with a population study).

And I agree with you when you say something needs to be done. I like the idea of a screening program, but it's a huge huge undertaking. There are many areas to be considered

-  What age do you start screening at?
-  The numbers of players involved (how many kids play GAA?) Where are we going to do the ECG? How many ECGs are we going to perform? Who's going to read the ECG (this is one area where you do need a specialist).
-  If someone tests 'positive' then you need to screen all first degree relatives
-  Genetic testing needs to be considered for all first degree relatives
-  Counselling needs to be arranged- a 'postive' test represents a huge life change (it's not as simple as giving up sport). There will be frequent doctors appointments, many more tests, drugs to be taken, possiblity of operations, even lifestyle changes such as having no alarm clocks and turning down the doorbell. There is a risk for the mother in future pregnancies. It's a huge life changing diagnosis.

So, who pays for all this? (I've no idea how the scheme in Italy was funded and who covered the medical costs of the patients)Will costs for treatment be covered? (some of the treatments at present for these conditions are experimental). Who will run the screening program? You'll need an experienced team in this field (not easy to find) and someone who can read an ECG properly (very very hard to find).

None of the above points are a good reason for not doing it. As you rightly say - just because it's difficult, does not mean that it isn't worth doing.

However, I don't think the resources are there for a nationwide GAA screening scheme yet. It would take a few years to get a scheme running and unforunately money will be a problem. The scheme will only pick up structural problems in the heart and not any of the other causes. But if we're serious about doing something we need to start somewhere.